.

• Debate over whether health insurance companies (e.g. in the US)

should be required to cover infertility treatment.
• Allocation of medical resources that could be used elsewhere
• The legal status of embryos fertilized in vitro and not transferred in vivo.
(See also Beginning of pregnancy controversy).
• Pro-life opposition to the destruction of embryos not transferred in vivo.
• IVF and other fertility treatments have resulted in an increase in multiple
births, provoking ethical analysis because of the link between multiple
pregnancies, premature birth, and a host of health problems.
• Religious leaders' opinions on fertility treatments; for example, the
Roman Catholic Church views infertility as a calling to adopt or to use
natural treatments (medication, surgery, and/or cycle charting) and
members must reject assisted reproductive technologies.
• Infertility caused by DNA defects on the Y chromosome is passed on
from father to son. If natural selection is the primary error correction
mechanism that prevents random mutations on the Y chromosome, then
fertility treatments for men with abnormal sperm (in particular ICSI) only
defer the underlying problem to the next male generation.
Many countries have special frameworks for dealing with the ethical and
social issues around fertility treatment.
• One of the best known is the HFEA – The UK's regulator for fertility
treatment and embryo research. This was set up on 1 August 1991
following a detailed commission of enquiry led by Mary Warnock in the
1980s
• A similar model to the HFEA has been adopted by the rest of the
countries in the European Union. Each country has its own body or
bodies responsible for the inspection and licencing of fertility treatment
under the EU Tissues and Cells directive
• Regulatory bodies are also found in Canada and in the state of Victoria
in Australia

CONCLUSIONS
Infertility is often not seen (by the West) as being an issue outside
industrialized countries.This is because of assumptions about
overpopulation problems and hyper fertility in developing countries, and a
perceived need for them to decrease their populations and birth rates.
The lack of health care and high rates of life-threatening illness (such as
HIV/AIDS) in developing countries, such as those in Africa, are supporting
reasons for the inadequate supply of fertility treatment options.Fertility
treatments, even simple ones such as treatment for STIs that cause
infertility, are therefore not usually made available to individuals in these
countries.
Despite this, infertility has profound effects on individuals in developing
countries, as the production of children is often highly socially valued and
is vital for social security and health networks as well as for family income
generation. Infertility in these societies often leads to social stigmatization
and abandonment by spouses.Infertility is, in fact, common in sub-
Saharan Africa. Unlike in the West, secondary infertility is more common
than primary infertility, being most often the result of untreated STIs or
complications from pregnancy/birth.
Due to the assumptions surrounding issues of hyper-fertility in developing
countries, ethical controversy surrounds the idea of whether or not access
to assisted reproductive technologies should comprise a critical aspect of
reproductive health or at least, whether or not the distribution and access
of such technologies should be subject to greater equity. However, as
highlighted by Inhorn the overarching conceptualisation of infertility, to a
great extent, disguises important distinctions that can be made within a
local context, both demographically and epidemiological and moreover,
that these factors are highly significant in the ethics of reproduction.
An important factor, argues Inhorn, is the positioning of men within the
paradigm of reproductive health, whereby because rates of general
infertility mask differences between male and female infertility, men
remain a largely invisible facet within the theorisation and discourse
surrounding infertility, as well as the related treatments and
biotechnologies. This is particularly significant given that male infertility
accounts for more than half of all cases of infertility and moreover, it is
evident that the attitudes and behaviours of men have profound
implications for the reproductive health of both individuals and couples.
For example, Inhorn notes that when couples in Egypt are faced with
seemingly intractable infertility problems - due to a range of family and
societal pressures that centre around the place of children in constituting
the gender identity of men and women - it is often the women who is
forced to seek continued treatment; this continues to occur, even in
known instances of male infertility and that the constant seeking of
treatment frequently becomes iatrogenic for the women.
Inhorn states that infertility often leads to “marital demise, physical
violence, emotional abuse, social exclusion, community exile, ineffective
and iatrogenic therapies, poverty, old age insecurity, increased risk of
HIV/AIDS, and death”Significantly, Inhorn demonstrates that this
phenomenon cannot simply be explained by a lack of knowledge, rather it
occurs in a complex interaction between the centrality of children in the
male gender identity as a symbol of maturity and the relative lack of
power of women in Egyptian society, whereby they effectively become
scapegoats for a culturally accepted narrative as a site of blame for the
lack of childlessness. It should be emphasised that this is not simply an
issue of “women oppressed by men” but rather, that men and women
both share the burden of this narrative, but in different, unequal and
highly complex ways.
Therefore, while the notion that reproductive health is a ‘women’s issue’,
may have powerful social currency, especially within popular discourse
and indigenous systems of meaning, the reality of infertility suggests that
medical and health paradigms have a significant part to play in
challenging the validity of this entrenched belief . Moreover, the
effectiveness of any therapeutic intervention, medical or otherwise will be
contingent on such outcomes and has an important part to play in the
alleviation of gendered suffering, especially the burden imposed on
women, who continue to suffer disproportionately from the effects of
infertility.
High costs may also be a factor and research by the Genk Institute for
Fertility Technology, in Belgium, claimed a much lower cost methodology
(about 90% reduction) with similar efficacy, which may be suitable for
some fertility treatment. At the 1994 United Nations International
Conference on Population and Development (ICPD) in Cairo, the
prevention and treatment of infertility was accepted into the program of
action for reproductive healthcare. Infertility has shown to have a greater
affect on developing nations than on birth rates or population control, but
also on a social level as well.
Reproduction is a large aspect of life for many cultures within developing
nations, and infertility can lead to social and familial problems such as
rejection or abandonment as well as personal psychological issues.
Currently, fertility treatment options and programs are only available
through private health sectors in developing nations and little-to-no
treatment is available through public health sectors. The fertility treatment
options offered through the private sectors are often costly or not easily
accessible. Additionally, counseling is considered an essential aspect of
fertility treatment, and due to lack of education and resources such forms
of therapy remain scarce as well. While quality fertility care is not readily
available in developing nations (such as sub-Saharan African countries),
a standard procedure of care could be easily implemented for a low cost
as a basic intervention. The lack of fertility treatment is problematic, and
high birth and population rates are every reason to implement treatment
options rather than reject them.